Guest: Dr. N. Lawrence EdwardsPresenter: Neal HowardGuest Bio: Dr. N. Lawrence Edwards is a specialist in internal medicine and rheumatology, and serves as professor of medicine in
the Division of Clinical Immunology at the University of Florida in Gainesville, Florida. He is also program director of the Medicine Residency Training Program and vice chairman for the Department of Medicine at the University. In addition, he is the chairman and chief executive officer for the Gout & Uric Acid Education Society.

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you so much for joining us on the program today. Our guest in studio is Dr. Lawrence Edwards, Professor of Medicine at the University of Florida also a Rheumatologist and Chairman of the Gout and Uric Acid Education Society. And he’s here in studio today with us to talk about the Go for Six Campaign, a campaign designed to raise awareness about the importance of knowing your serum uric acid level in order to combat gout. Good afternoon and welcome back to the program Dr. Lawrence Edwards.

Dr. Lawrence Edwards: Thank you Neal. It’s a pleasure to be here again.

N: Thanks. Now the “Go for Six Campaign,” talk about this campaign. Why is it called Go for Six?

E: Well it’s to emphasize the new guidelines that have come out over the past five years both from the European Rheumatology Group as well as the American College of Rheumatology. The very central to the treatment of gout is lowering uric acid. Gout itself is caused by an accumulation of uric acid in the body usually over the years and decades and the treatment of it in the long term is to get your uric acid levels back down below the level where uric acid comes out of solution. And most of us our uric acids are low enough that uric acid stays dissolved in our blood without much problem but once it gets over a certain number and then it actually can form precipitates, it’s very similar to if you’re adding too much sugar to your iced tea it gets to a point that it just stops dissolving. Well that’s how people should think about uric acid in the body. The number that uric acid really starts coming out of solution is around 7 mg/dl and so both the European and American Rheumatology groups settled on a value of 6.0 mg/dl being our target for therapy with uric acid lowering drugs, that way we’re well below the solubility product and the uric acid can gradually start dissolving that’s been deposited around the body.

N: Well how does one get into a situation where the uric acid is above normal or acceptable or healthy levels?

E: Well in truth, about 25% of the male population in this country now has an elevated serum uric acid level, at least elevated above 7.0 mg/dl. Genetics plays a huge role in this, obesity certainly contributes and some of the medications that people are commonly on these days for instance low-dose aspirin will raise your uric acid levels. So there’s a lot of push across the whole population for uric acid levels to become elevated. And then out of those that have elevated uric acid, it’s about 1 in 5 will develop gout and those tend to be the ones with a higher gout levels usually up in the 8, 9, 10 and above range, so gout is very much a product of how high your uric acid is and how long it’s been elevated like that.

N: In addition to the Go for Six Campaign, you recently conducted a survey, the Gout and Uric Acid Education Society conducted a survey that showed that only 20…% of us correctly identified gout as a form of arthritis. Did you also discover whether or not diet played a role in reversing or preventing gout? Is this something that we just are gonna have to deal with or if we begin a healthy diet, say in your teens, is gout something that we don’t have to worry about?

E: Right. Well certainly watching your weight in your teens, so it’s a very helpful thing for minimizing your risk of getting gout. Diet itself has been greatly emphasized, in fact if you go on the internet and look up gout, most of the websites there are about some sort of magic formulation or diet that’s goanna control this. That’s not true, diet itself doesn’t cause gout and you can’t cure gout by dietary restrictions. You can lower your uric acid a little bit by eliminating some of the very high purine content foods, purine so the substances that breakdown and form uric acid and those include things like organ meats, liver and sweetbread kidneys things that most of us don’t eat a whole lot of. But then red meats, pork, certainly are contributors, shellfish and small fish like anchovies, those are very high in purines and restricting those is a good idea not that again it’s gonna cure gout by itself but that it’s gonna be helpful in preventing the ups and downs of your uric acid level in your blood that cause the flares of gout. Beer, of course is always the one that’s talked about most and it is a fairly common trigger for gout flares.

N: You’ve got a website, gouteducation.org. When our visitors go to this website, what would we expect to find especially when it comes to this Go for Six Campaign?

E: Well we’ve been emphasizing this target of uric acid for a couple of years now. The Gout and Uric Acid Society does have their gout website, the gouteducation.org now for eleven years and we’ve emphasized different things over the years. We’re really pushing the treat for target because we think this is the new approach that’s gonna be most helpful to get more patients well-controlled with gout. In the past and still in a lot of physicians’ offices they’re on a treat the symptoms type of approach, so that if somebody comes in with a flare they’ll treat them with some corticosteroid or some non-steroidal anti-inflammatory drugs or colchicine the commonly used medications for the flare but they won’t approach the underlying problem which is the elevated uric acid levels. So this is a really a reach out, our website was first and foremost a patient education site, we’re trying to get the level of information out to patients and dispel some of the myths about this disease. But we also added a physicians’ side to the website and we have videos on there of some gout experts discussing these various aspects as well as updates on recent research papers that are out that we put on this website.

N: We talked about misconceptions and things of that nature in another segment when you were here before. But talk a little bit about the mindset of the patient who either suspects that they may have gout or know that they have gout but maybe don’t want to talk about it. Is that something that you’ve seen in your experience?

E: That’s actually very common. Gout is a genetic disease, so it’s really quite common for people that develop these painful toes and ankles and knees to known that their uncle, their father, their grandfather, somebody in their family had gout and so they recognize it pretty rather late. They don’t need the physician to tell them that they’ve been afflicted by the disease that runs in the family. And it embarrasses them because there has been this mythology out there that the reason you have gout is that you’re an over-indulger in certain foods, beer or too much to eat in general and so they view it as a self-inflicted disease which decreases the likelihood that they’re gonna come in and look for therapies because they’re too busy kind of internally damning themselves for acquiring this disease. The truth is it’s genetic, that’s very thin and healthy people get it. In fact our spokesperson, several years ago for the Gout Society was a former outstanding college and NBA basketball player and was at the time the head coach of the Philadelphia 76ers and was one of the most athletic people that you could imagine and he was afflicted by it. So he recognized that there is this prejudice against gout, that there is too much of this self-condemnation for people that got it and so he was our spokesman and really addressed this issue very well.

N: And at gouteducation.org are there may be some tips to help patients or physicians as well start that conversation to get treatment as quickly as possible?

E: Certainly are. And also the family members that we direct, husbands and wives of people with gout to this so that then our part of the course of people keeping the guilt upon the poor gout sufferers. So we go through the various mechanisms of how people acquire elevated uric acid levels, that approaches are to get under a good therapy and to get the uric acid levels down, again to less than 6.0 mg/dl and if they do that the gout will over time resolve and become a big non-issue as long as they stay on their medications.

N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. And we’ve been in studio talking with Dr. Lawrence Edwards, Specialist in Internal Medicine and Rheumatology and serves as Professor of Medicine in the Division of Clinical Immunology at the University of Florida in Gainesville. He’s also Program Director of the Medicine Residency Training Program and Vice-Chairman at the Department of Medicine at the University. In addition, he’s Chairman and Chief Executive Officer for the Gout and Uric Acid Education Society. And he’s been with us in studio today talking about the Go for Six Initiative, designed to raise awareness about the importance of all of us keeping our serum uric levels down. It’s been great having you here with us today Doctor.

E: It’s been my pleasure Neal.

N: Thank you. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.